20 free RD exam practice questions

Correct answer: A · The association is not statistically significant, because the interval includes 1.0

A relative risk of 1.0 means no difference between groups. When the 95% confidence interval for a ratio includes 1.0, as 0.94 to 1.48 does, the result is not statistically significant at the 0.05 level: the data are compatible with lower risk, no difference, or higher risk. A point estimate above 1.0 does not make the result significant on its own, and a lower limit below 1.0 does not show a protective effect. Even a significant result from an observational cohort shows association, not causation, because confounders such as overall diet quality or income can explain it. The RDN would describe this as no clear evidence of increased risk and look for stronger or pooled evidence.

Look for this next time: If a 95% confidence interval for a relative risk or odds ratio includes 1.0, the result is not statistically significant.

Correct answer: C · 1.4 FTE

Hours of coverage needed each week = 8 hours × 7 days = 56 hours. FTEs = hours needed ÷ hours per FTE = 56 ÷ 40 = 1.4 FTE. Checking by year: 56 × 52 = 2,912 hours, and 2,912 ÷ 2,080 = 1.4. A single FTE covers only 5 of the 7 days. A total of 1.2 FTE would provide 48 hours a week, one 8-hour shift short. A figure of 1.75 FTE (70 hours) comes from dividing 56 by a 32-hour part-time week instead of a 40-hour full-time week. Paid time off is usually added separately as a relief factor, so the final staffing figure ends up slightly above 1.4.

Look for this next time: FTEs needed = coverage hours per week ÷ 40; an 8-hour post staffed 7 days a week needs 1.4 FTE.

Correct answer: B · Can you perform the essential functions of this job, with or without accommodation?

Under the Americans with Disabilities Act, an employer may describe the job's essential functions, such as lifting, and ask whether an applicant can perform them, with or without reasonable accommodation. Before a job offer, the employer may not ask whether an applicant has a disability or about its nature or severity, so the first question is unlawful. Questions about age invite claims under the Age Discrimination in Employment Act, and questions about children or childcare are the kind EEOC guidance warns can be used as evidence of sex discrimination. Asking every applicant the same job-related questions keeps interviews consistent and defensible.

Look for this next time: Before a job offer, ask whether applicants can perform essential job functions with or without accommodation, never about disabilities.

Correct answer: D · Place

The marketing mix, or four Ps, covers product (the service itself), price (what clients pay), promotion (how the service is communicated, such as advertising and outreach), and place (how and where clients can get it, including locations, hours, and delivery channels). Adding evening hours and telehealth changes access and distribution, which is place. The counseling service is unchanged, so product is the same. Fees did not change, so price is the same. No new advertising or outreach was added, so promotion is unchanged, although the clinic would likely promote the new hours next.

Look for this next time: In the four Ps, place means access and distribution, such as hours, locations, and telehealth delivery.

Correct answer: C · Study

In the Plan-Do-Study-Act (PDSA) cycle, the team plans a change and predicts its effect (Plan), carries it out on a small scale while collecting data (Do), analyzes the data and compares the results with baseline and with the prediction (Study), and then decides whether to adopt, adapt, or abandon the change (Act). Comparing the new screen-to-assessment times with baseline and with the predicted improvement is the Study step. The 4-week trial on one unit was the Do step. Act comes next, when the team decides to spread the protocol, modify it, or test another idea.

Look for this next time: In PDSA, Study means analyzing results against baseline and predictions; Act means adopting, adapting, or abandoning the change.

Correct answer: A · A 4-year-old child

WIC serves pregnant women, breastfeeding women up to the infant's first birthday, non-breastfeeding women up to 6 months after the end of pregnancy, infants, and children up to their fifth birthday, who meet the income rules (at or below 185% of the federal poverty guidelines, or adjunctively through programs such as SNAP or Medicaid) and are at nutritional risk. A 4-year-old is within the child category. A 7-year-old is past the fifth birthday. A woman who is not breastfeeding is in a WIC category only up to 6 months postpartum. Older adults are not a WIC category; programs such as SNAP, Older Americans Act nutrition services, or the Commodity Supplemental Food Program serve them.

Look for this next time: WIC serves pregnant women, breastfeeding women to 12 months, non-breastfeeding women to 6 months postpartum, infants, and children under 5.

Correct answer: D · Process evaluation

Process evaluation examines how a program is being delivered: who attends (reach), whether sessions are delivered as planned (fidelity), and how participants receive them (satisfaction). Attendance logs, content checklists, and session ratings are typical process measures. A needs assessment comes before planning, to identify a community's needs and resources. Impact and outcome evaluations measure a program's effects, such as changes in knowledge, skills, behavior, or health status; texts differ on which term covers short-term and long-term effects, but both concern results rather than delivery. Process data gathered midway let the RDN fix delivery problems while the program is still running.

Look for this next time: Process evaluation tracks reach, fidelity, and satisfaction during delivery; impact and outcome evaluations measure a program's effects.

Correct answer: B · Preparation

In the Transtheoretical Model, preparation is the stage in which a person intends to act soon, usually within the next month, and has often taken small steps, such as buying walking shoes. Contemplation means intending to change within about 6 months, while still weighing pros and cons without a firm plan. Action means the behavior has been changed within the past 6 months, and he has not started walking yet. Maintenance means the change has been sustained for more than 6 months. At the preparation stage, the RDN helps him set a specific plan, such as days, times, and a backup option, and anticipate barriers.

Look for this next time: Preparation means planning to act within about a month, often with small steps taken; action means the change has begun.

Correct answer: C · Behavioral Risk Factor Surveillance System (BRFSS)

The BRFSS is CDC's state-based telephone survey of adults aged 18 and older. It collects self-reported data on health-related risk behaviors, chronic conditions, and use of preventive services, so it provides state-level estimates for adults. NHANES combines interviews with physical examinations and laboratory tests and is designed mainly for national estimates, not state ones. The YRBSS surveys students, mainly in high school, not adults. The National Vital Statistics System compiles births and deaths, not behaviors. Combining BRFSS estimates with local data helps the RDN describe the problem and set program priorities.

Look for this next time: BRFSS gives state-level, self-reported adult behavior data; NHANES adds exams and labs for national estimates; YRBSS covers youth.

Correct answer: D · About 1,370 kcal/day

The Mifflin-St Jeor equation for women is REE = (10 × weight in kg) + (6.25 × height in cm) − (5 × age in years) − 161. Step by step: 10 × 70 = 700; 6.25 × 165 = 1,031.25; 5 × 40 = 200. REE = 700 + 1,031.25 − 200 − 161 = 1,370.25, or about 1,370 kcal/day. Using the men's constant (+5 instead of −161) gives about 1,536. Leaving out the age term gives about 1,570. About 1,781 is the REE multiplied by an activity factor of 1.3, an estimate of total energy expenditure rather than REE. When REE cannot be measured, the Academy's Evidence Analysis Library has identified Mifflin-St Jeor as the most accurate predictive equation for healthy adults, including those with overweight or obesity.

Look for this next time: Mifflin-St Jeor for women: 10 × kg + 6.25 × cm − 5 × age − 161; apply an activity factor only for total needs.

Correct answer: A · Malnutrition, stage 1 (moderate)

The GLIM criteria (2019) diagnose malnutrition when at least one phenotypic and one etiologic criterion are present. Weight loss = (80 − 74) ÷ 80 × 100 = 7.5% in 4 months, which meets the phenotypic criterion of more than 5% within the past 6 months. Eating 50% or less of energy requirements for more than 1 week meets the etiologic criterion of reduced intake, and cancer can also count as disease-related inflammation. GLIM grades 5% to 10% loss within 6 months as stage 1 (moderate); stage 2 (severe) needs more than 10% within 6 months. A normal BMI does not rule out malnutrition, because one phenotypic criterion is enough. He is not merely at risk: he meets both required criteria.

Look for this next time: GLIM needs one phenotypic and one etiologic criterion; 5% to 10% weight loss within 6 months is stage 1 (moderate).

Correct answer: B · About 70 to 84 g per day

The 2020 KDOQI Clinical Practice Guideline for Nutrition in CKD recommends 1.0 to 1.2 g of protein per kg of body weight per day for metabolically stable adults on maintenance hemodialysis or peritoneal dialysis; his dry weight matches his ideal weight, so 70 kg is the basis. For 70 kg: 1.0 × 70 = 70 g and 1.2 × 70 = 84 g per day. Dialysis removes amino acids and adds catabolic stress, so protein is not restricted at this stage. About 39 to 42 g reflects the 0.55 to 0.6 g/kg low-protein diet the guideline describes for CKD stages 3 to 5 without dialysis or diabetes, and about 20 to 30 g reflects its very low-protein diet (0.28 to 0.43 g/kg) with keto acid analogs. About 105 to 140 g (1.5 to 2.0 g/kg) exceeds the recommendation without a specific reason.

Look for this next time: For metabolically stable adults on maintenance dialysis, KDOQI 2020 recommends 1.0 to 1.2 g of protein per kg per day.

Correct answer: D · 63 mL/h

First find the daily volume: volume = energy goal ÷ caloric density = 1,800 kcal ÷ 1.2 kcal/mL = 1,500 mL per day. Then divide by the hours of infusion: 1,500 mL ÷ 24 h = 62.5 mL/h, which rounds to about 63 mL/h (63 × 24 = 1,512 mL, about 1,814 kcal). A rate of 75 mL/h comes from dividing 1,800 by 24 as if the formula provided 1 kcal/mL. A rate of 90 mL/h comes from multiplying by 1.2 instead of dividing. A rate of 50 mL/h would be right only for a 1.5 kcal/mL formula. The RDN also checks protein and free water against the patient's needs, because a formula's free water is less than its total volume.

Look for this next time: Continuous tube-feeding rate = (kcal goal ÷ kcal per mL) ÷ hours of infusion.

Correct answer: C · Start at 10–20 kcal/kg, give thiamin first, and check K, Mg, and P every 12 hours

Very low BMI, minimal intake for 2 weeks, and chronic alcohol use put her at high risk for refeeding syndrome. The 2020 ASPEN consensus recommendations advise starting with 100 to 150 g of dextrose or 10 to 20 kcal/kg for the first 24 hours and advancing by about 33% of goal every 1 to 2 days, giving thiamin before feeding in patients at risk, and checking potassium, magnesium, and phosphorus before feeding and every 12 hours for the first 3 days in high-risk patients. Normal pre-feeding levels do not remove the risk, because electrolytes shift into cells after carbohydrate is reintroduced. Weekly checks would miss that early drop. Withholding nutrition prolongs starvation; low levels are corrected while feeding starts slowly.

Look for this next time: With refeeding risk, start low (10 to 20 kcal/kg), give thiamin first, and monitor potassium, magnesium, and phosphorus closely.

Correct answer: A · Keep vitamin K intake consistent week to week rather than avoiding these foods

Warfarin works by antagonizing vitamin K–dependent clotting factors, so large, sudden changes in vitamin K intake shift the INR: a sharp increase lowers it, and a sharp decrease raises it. The goal is consistency, not avoidance. He can eat leafy greens in steady amounts, and his anticoagulation team adjusts the warfarin dose to his usual intake. Cutting out greens removes nutrient-dense foods, and adding them back suddenly would lower his INR; a sharp increase in greens has the same effect. Starting a vitamin K supplement on his own also changes his anticoagulation and should happen only with his prescriber's direction. Planned diet changes should be reported so the INR can be checked.

Look for this next time: With warfarin, keep vitamin K intake consistent rather than avoiding greens, and report major diet changes.

Correct answer: B · Inadequate oral intake related to nausea and early satiety, as evidenced by 40% intake for 10 days

A PES statement names the nutrition Problem (a standardized nutrition diagnosis), its Etiology (the cause, after "related to"), and the Signs and symptoms that show the problem exists (after "as evidenced by"). Option B does this: inadequate oral intake is the problem, nausea and early satiety are causes nutrition intervention can address, and measured intake of 40% for 10 days is the evidence. Option D reverses the etiology and the evidence. Option A names a medical diagnosis and a treatment instead of nutrition-specific causes and measurable signs, and malnutrition needs its own criteria. Option C makes a symptom the problem; nausea belongs in the etiology or the signs, not as the nutrition diagnosis.

Look for this next time: A PES statement is Problem related to Etiology as evidenced by Signs and symptoms, with the signs measurable.

Correct answer: C · Vitamin C

Perifollicular hemorrhages, corkscrew hairs, and swollen or bleeding gums are classic signs of vitamin C deficiency (scurvy), because vitamin C is needed to form stable collagen in blood vessel walls and connective tissue. His diet lacks fruits and vegetables, the main sources. Vitamin A deficiency shows up as night blindness, Bitot's spots, and follicular hyperkeratosis (rough bumps around hair follicles, without hemorrhage). Riboflavin deficiency causes angular stomatitis, cheilosis, and glossitis. Zinc deficiency causes poor wound healing, taste changes, and dermatitis. The RDN confirms the picture with the intake history and, when appropriate, laboratory data, then plans repletion and a diet that includes fruits and vegetables.

Look for this next time: Perifollicular hemorrhages, corkscrew hairs, and bleeding gums on a nutrition-focused physical exam suggest vitamin C deficiency.

Correct answer: D · 68°F at 3:45 p.m.; 41°F at 7:30 p.m.

The FDA Food Code (section 3-501.14) requires cooked time/temperature control for safety food to cool from 135°F to 70°F within 2 hours, and from 135°F to 41°F or less within a total of 6 hours. Starting at 2:00 p.m., the chili must reach 70°F by 4:00 p.m. and 41°F by 8:00 p.m. Log D reaches 68°F at 3:45 (1 hour 45 minutes) and 41°F at 7:30 (5 hours 30 minutes in total), so it meets both limits. Log A misses the first stage, at 75°F after 2 hours. Log B reaches 70°F only after 2.5 hours. Log C passes the first stage but takes 7 hours to reach 41°F. Shallow pans, ice baths, and ice paddles help large batches meet both limits.

Look for this next time: Cool cooked TCS food from 135°F to 70°F within 2 hours and to 41°F or below within 6 hours in total.

Correct answer: B · 25 lb

Edible portion (EP) is what remains after trimming; as-purchased (AP) is what must be bought. AP = EP ÷ yield as a decimal: 22 lb ÷ 0.88 = 25 lb. Check: 25 lb × 0.88 = 22 lb usable. Multiplying 22 × 0.88 (about 19.4 lb) shrinks the order instead of enlarging it. Adding 12% to the EP (22 × 1.12, about 24.6 lb) underestimates the order, because the 12% loss applies to the larger AP weight, not to the EP: 24.6 × 0.88 is only about 21.7 lb. Ordering 22 lb ignores trim loss and leaves the recipe short. In practice, the manager also rounds up to the purchase unit, such as a full case.

Look for this next time: As-purchased amount = edible-portion amount ÷ yield (as a decimal); multiplying by the yield under-orders.

Correct answer: A · Egg yolk, through its lecithin and lipoproteins

Mayonnaise is an oil-in-water emulsion: tiny oil droplets are dispersed in a water phase that comes from the yolk and vinegar. Emulsifiers have a water-loving part and a fat-loving part, so they coat the droplets and keep them from merging. Egg yolk supplies lecithin (a phospholipid) and lipoproteins that do this. Vinegar adds flavor, acidity, and part of the water phase but is not the emulsifier. Salt seasons the mayonnaise but does not form the layer around the droplets. Oil is the dispersed phase being emulsified. The oil must be added slowly; adding it too fast can keep the oil-in-water emulsion from forming.

Look for this next time: In mayonnaise, egg yolk lecithin and lipoproteins act as the emulsifier that keeps oil droplets dispersed in the water phase.